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2 Prevalence The average prevalence of problem opioid use among adults (15 64) is estimated at 0.41%, the equivalent of 1.4 million problem opioid users in Europe in The injection of drugs continues to be an important mechanism for the transmission of infectious diseases, including HIV/AIDS and hepatitis C. Injecting drug use accounts for 58% of all HCV diagnoses Drug use is one of the major causes of mortality among young people in Europe, both directly through overdose (drug-induced deaths) and indirectly through drug-related diseases and accidents, violence and suicide. Users of opioids (mainly heroin) represent 48% of all clients who entered specialised treatment in 2011 in Europe ( clients) and around 30% of those entering treatment for the first time. EWDD, report 2012

3 How heroine does affect the brain Feeling a surge of euphoria ( rush ) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. After the initial euphoria, the user may go into an alternately wakeful and drowsy state. About 4 houres Sometimes nausea, vomitus. Very pain-relieving 3

4 Risks and damage Fatal overdose, spontaneous abortion, Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses Infectious diseases like hepatitis C and HIV Constipation and gastrointestinal cramping, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the user as well as from heroin s effects on breathing. Physical dependence 4

11 Treatment goals Abstinence oriented treatment from all prescription, non-prescription and illegal opiates which starts with detoxification and if possible followed by a treatment focused on relapse prevention. A treatment focused on complete abstinence from all non-prescription and illegal opiates by a maintenance treatment with an effective dose opiate agonists: methadone, buprenorphine or heroin on medical prescription. A treatment aimed at reducing the use of non-prescribed and illicit opiates and the prevention of drug-related harm through a maintenance treatment with a lower dose of methadone or buprenorphine possibly combined with participation in a needle exchange program. Care with the (provisional) goal: reduction of the drug related harm, (user rooms, stable living situation, activation program) without the requirement to participate at once in one of the treatment programs mentioned above ("housing first").

12 Effects of heroin and methadone HEROIN Full agonist Flash, euphoria and sedation Rapidly metabolised Withdrawal for a short time Tolerance quickly Illicit drug Composition not known METHADONE Full agonist Do not create euphoria and sedation Slow metabolisation Withdrawal for weeks Tolerance quickly Prescribed Controlled composition

14 Heroïn Assisted treatment (HAT) Patients receiving HAT appear to be more likely to be retained in treatment than those engaging in oral methadone substitution therapy. Compared to M substitution, HAT brings about additional reductions in illicit heroin use Consistently (almost entirely, but not completely) now considered as second-line treatment Direct medical or nursing supervision of all injectable doses

16 Psycho-social interventions Brief motivational interventions are effective in general practice but not in addition to an addiction treatment CBT without medication could help to achieve abstinence in opiate addicts who refuse to participate in substitution treatment There is evidence that Contingency Management is usefull as an addition to methadone maintenance treatment. CM has positive effects on abstinence and reducing use of heroin There are indications that standard CBT may be of value as an addition to substitution treatment for patients with many psychiatric comorbidity.

Heroin Heroin is a synthetic opiate drug that is highly addictive. It is made from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears

Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown

Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown

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What is heroin? Heroin is an opiate/depressant drug processed from morphine, a naturally occurring substance in the Asian poppy plant. Morphine has been used as a narcotic for thousands of years. According

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HEROIN AND RELATED OPIATES DAVID J. NUTT Psychopharmacology Unit, Bristol University Heroin is a derivative of morphine and both belong to a large family of drugs called the opiates, that were originally